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0 <br />UNIFIED PROGRAM CONSOLIDATED FORM <br />TANKS <br />UNDERGROUND STORAGE TANKS - TANK PAGE 2 <br />SYSTEM TYPE ❑ 1. PRESSURE SUCTION Q 3. GRAVITY 458. <br />Q 1. PRESSURE Q 2. SUCTION [:13. GRAVITY <br />ass. <br />MANUFACTURER '� SINGLE WALL Q 3. LINED TRENCH Q 99. OTHER 464 <br />0-1. SINGLE WALL <br />❑ 95. UNKNOWN <br />46E. <br />Q 2. DOUBLE WALL Q 95. UNKNOWN <br />[12. DOUBLE WALL <br />Q 99. OTHER <br />MANUFACTURER (f�K/s/ <br />461. MANUFACTURER <br />.GKBARESTEEL Q 6. FRP COMPATIBLE W/100% METHANOL <br />Q 1. BARE STEEL <br />463. <br />116. FRP COMPATIBLE W/100% METHANOL <br />Q 2. STAINLESS STEEL Q 7, GALVANIZED STEEL <br />Q 2. STAINLESS STEEL <br />Q 7. GALVANIZED STEEL <br />Q 3. PLASTIC COMPATIBLE WITH CONTENTS Q 95. UNKNOWN <br />Q 3. PLASTIC COMPATIBLE W/ CONTENTS <br />Q 8. FLEXIBLE (HDPE) <br />❑ 99. OTHER <br />Q 4. FIBERGLASS Q 8. FLEXIBLE (HDPE) Q 99. OTHER <br />Q 4. FIBERGLASS <br />❑ 9. CATHODIC PROTECTION <br />115 STEEL W/COATING ❑ 9. CATHODIC PROTECTION 464. <br />115 STEEL W/COATING <br />❑ 95. UNKNOWN <br />465. <br />SINGLE WALL PIPINGl,' 466 <br />�O� <br />PRESSURIZED PIPING (Check all that apply): e.�-- <br />❑ 1. ELECTRONIC LME LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP <br />SHUT-OFF FOR LEAK, SYSTEM FAILURE, AND SYSTEM DISCONNECTION <br />+AUDIBLE AND VISUAL ALARMS. <br />E12. MONTHLY 0.2 GPH TEST <br />03. ANNUAL INTEGRITY TEST (0.1 GPH) <br />CONVENTIONAL. SUCTION SYSTEMS <br />Q S. DAILY VISUAL MONITORING OF PUMPING SYSTEM + TRIENNIAL PIPING <br />INTEGRITY TEST (0.1 GPH) <br />SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): <br />07. SELF MONTTORINO <br />GRAVITY FLOW <br />09. BIENNIAL INTEGRITY TEST (0.1 GPH) <br />SECONDARILY CONTAINED PIPING //f7 <br />PRESSURIZED PIPING (Check all that apply): /✓ // <br />10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL <br />ALARMS AND (Check one) <br />Q t AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br />Q b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM <br />DISCONNECTION <br />Qc. NO AUTO PUMP SHUT OFF <br />Q 11. AUTOMATIC LME LEAK DETECTOR (3.0 GPH TEST) ATTH FLOW SHUT <br />OFF OR RESTRICTION <br />Q 12. ANNUAL INTEGRITY TEST (0.1 GPH) <br />SUCTION/GRAVITY SYSTEM <br />Q 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS <br />EMERGENCY GENERATORS ONLY (Check all that apply) <br />014, CONTINUOUS SUMP SENSOR W ITHGUT AUTO PUMP SHUT OFF <br />AUDIBLE AND VISUAL ALARMS <br />015. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST)ITW HOUT FLOW <br />SHUT OFF OR RESTRICTION <br />016. ANNUAL INTEGRITY TEST (0.1 GPH) <br />017. DAILY VISUAL CHECK <br />SINGLE WALL PIPING 467 <br />PRESSURIZED PIPING (Check all that apply): <br />01. ELECTRONIC LME LEAK DETECTOR 3.0 GPH TEST WITH AUTO PUMP <br />SHUT OFF FOR LEAK SYSTEM FAILURE, AND SYSTEM DISCONNECTION <br />+AUDIBLE AND VISUAL ALARMS. <br />Q 2. MONTHLY 0.2 GPH TEST <br />03. ANNUAL INTEGRITY TEST (0.1 GPH) <br />[14. DAILY VISUAL CHECK <br />CONVENTIONAL SUCTION SYSTEMS (Check all that apply) <br />115. DAILY VISUAL MONITORING OF PIPING AND PUMPING SYSTEM <br />[16. TRIENNIAL INTEGRITY TEST (0.1 GPH) <br />SAFE SUCTION SYSTEMS (NO VALVES IN BELOW GROUND PIPING): <br />07. SELF MONITORING <br />GRAVITY FLOW (Check all that apply): <br />[18. DAILY VISUAL MONITORING <br />09. BIENNIAL INTEGRITY TEST(0.1 GPH) <br />SECONDARILY CONTAINED PIPING <br />PRESSURIZED PIPING (Check all that apply): <br />10. CONTINUOUS TURBINE SUMP SENSOR WITH AUDIBLE AND VISUAL <br />ALARMS AND (Check coal <br />Q a. AUTO PUMP SHUT OFF WHEN A LEAK OCCURS <br />Q b. AUTO PUMP SHUT OFF FOR LEAKS, SYSTEM FAILURE AND SYSTEM <br />DISCONNECTION <br />Qc. NO AUTO PUMP SHUT OFF <br />Q 11. AUTOMATIC LEAK DETECTOR <br />Q 12. ANNUAL INTEGRITY TEST (0.1 GPH) <br />SUCTION/GRAVITY SYSTEM <br />Q 13. CONTINUOUS SUMP SENSOR + AUDIBLE AND VISUAL ALARMS <br />EMERGENCY GENERATORS ONLY (Check all that apply) <br />Q 14. CONTINUOUS SUMP SENSOR WITHOUT AUTO PUMP SHUT OFF <br />AUDIBLE AND VISUAL ALARMS <br />Q 15. AUTOMATIC LINE LEAK DETECTOR (3.0 GPH TEST) <br />Q 16. ANNUAL INTEGRITY TEST (0.1 GPH) <br />[117. DAILY VISUAL CHECK <br />DISPENSER CONTAINMENT 468. 1 Q 1. FLOAT MECHANISM THAT SHUTS OFF SHEAR VALVE [14. DAILY VISUAL CHECK 469. <br />DATEn INSTALLED Q2. CONTINUOUS DISPENSER PAN SENSOR 'AUDIBLE AND VISUAL ALARMS Q5. TRENCH/LMERM ICKTOMN <br />D/)r ❑3. CONTINUOUS DISPENSER PAN SENSOR WITH AUTO SHUT OFF FOR <br />DISPENSER+ AUDIBLE AND VISUAL ALARMS NONE <br />1 certify that the information provided herein is hue and accurate to the best of my knnwledoe <br />Permit Number (Agency use only) 473. 1 Petn it Approved By (Agency use only) 474. 1 Permit Expiration Date (Agency use ody) 475. <br />UPCF hwfwrc-b (1/99) - 3/4 http://www.unidocs.org Rev. 02/16/00 <br />